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The language of nursing was first mentioned by Florence Nightingale in her book Notes on Nursing when she stated that, "words are great tools." It is well understood that verbal patterns can either interfere with or enhance effective patient communication. Nursing 101 impresses the need to establish patient rapport. In doing so, we significantly impact patient cooperation, understanding and outcome.

Nurses communicate through facial gestures, body language, written, visual and verbal communication. We differ from other species in our ability to use verbal communication. Rudyard Kipling said, "Words are, of course, the most powerful drug used by mankind." Often nurses forget that words are just as important as antibiotics, pain medicines, surgery and other medical treatments. The purpose of this article is to describe the difference in therapeutic and toxic language in nursing.

Nursing is the most trusted of all professions. Unfortunately, as many nurses and nurse anesthetists talk to their patients, they are not aware of how that trust impacts the words they use. When nurses use suggestions they create perceptions. That perception is truth to the patient. Biological research done by Bruce Lipton, Ph.D. describes how changing thinking changes the brain, which changes a behavior or a physiological response. His research demonstrates that words have the ability to change pain and the healing process. The subconscious mind does not think. It only responds to the perceptions from the conscious thinking brain. It responds equally to both negative (toxic) suggestions and positive (therapeutic) suggestions. Every suggestion creates a physiological or biochemical response. People who blush from an embarrassment or wake up in a cold sweat from a nightmare or get goose bumps from a story demonstrate this effect of perception.

"The difference between the right word and the almost right word is the difference between lightning and the lightning bug..." -Mark Twain

A person in pain, fear, or panic is considered to be in an "altered state of consciousness." At such times, healing suggestions can be spoken to the body and accepted as truth by the brain.

Words affect the following functions:

Pain

Bowel motility

Heart Rate

Smooth muscle tension

Contractions

Sweating

Blood pressure

Allergic responses

Bleeding

Asthma

Inflammatory response

Immune response

Itching

Allergic responses

Respiration

Negative or toxic language is language or words that create affirmations, evoke emotional and/or physical responses, or alter perceptions in a negative manner.

Words can paint mental pictures, change behaviors, and alter symptoms or sensations. This phenomenon can be demonstrated by thinking about eating a lemon. Try it. Think about eating a lemon, smelling it, biting into it and remember what a lemon tastes like. You may have made a face, experienced salivation or even jaw pain. The subconscious mind does not think or reason, it only responds to thoughts created by the words we speak and hear.

Words used are important in helping patients deal with fears and built-in anxieties about treatments, findings, cost, inconvenience, loss of control, major life events, threat of loss or disfigurement and alien environments. Have you or a family member experienced a situation where the words used by a health care provider caused a change in your feelings, good or bad?

Suggestions should be positive and affirming, clear and specific, firm, believable, rich in imagery, and beneficial. Suggestions should avoid anger or blame. In other words, Don't say, "Boy, you really broke yourself up," or "How could you do something so stupid?" Also avoid any negative words like "pain" and "hurt."

Some suggestions that can be edited for any situation or procedure.

Don't Say

Say

"This isn't going to hurt."

"You might feel a slightly cool pressure as the bandage is applied."

"Don't give up."

"Focus all your energy on healing."

"Don't be afraid."

"We are well trained in how to take care of you."

"A little bee sting." (There is no such thing as little bee sting.)

"Some people feel this; some people don't."

"Looks like that must hurt a lot."

"Let me know where you feel any discomfort."

"Do you feel like vomiting?"

"You may have a warm hungry feeling in your stomach."

"We're going to put you to sleep."

"I am giving you some medication that will let you gently go to sleep."

"Don't worry, you won't wake up!"

"I will be with you the entire time to make sure you stay asleep during your surgery."

"Are you feeling better?"

"You look/sound like you are feeling better

"See if this Nitroglycerin tablet will help."

"Take this. It will make you feel more comfortable"

"Has the oxygen helped your breathing?"

"The oxygen has really helped your breathing. You are looking better already."

Some times it is a good idea to give the suggestion in an indirect manner as in telling a story or using an analogy. An example is: "I know some one who had a burn like this. He was on television. He was in an ambulance and his arm looked just about like yours does now. Later, I saw him released from the hospital and he looked as good as new. He was smiling. You will be smiling also."

Has this ever happened to you? I went for blood work and the phlebotomist said: "Sit down and roll up your sleeve. I am going to be your worst enemy today." I asked why. She said, "Because I am going to hurt you." She could have said: "Relax this won't take long. You may not even feel it."

I do the following in the holding area for surgery, but it could be used anywhere, for any reason to reframe the patient's thinking. I ask, "Is there some place you would rather be than here?" When they say, "Yes," I ask: "Where would you rather be?" When they tell me, I simply say: "Go there and create that place in your imagination."

When starting an IV I introduce myself to the patient. I tell the patient to think of water hoses as a metaphor, to dilate the blood vessels. I say: "Focus on the opposite arm and you might notice the tourniquet I am putting on may make the arm go numb-like when it goes to sleep when you lie on it. Then I say: Remember the last time your hand got so cold that it got numb? Well, this cold alcohol may do the same."

Sometimes, I will gently pinch the area or pull the hair at the wrist and say: What I am going to do will feel about like this, if you feel anything at all. Some people feel it and some don't." I continue talking while starting the IV as a means of distraction. Most often the IV is in before the patient knows it.

When putting the patient to sleep for surgery, hypnotic medications are used. Therefore, what is said takes on a magnified response and during the induction of sedation or anesthesia, you can say"

• "I will be with you during the entire procedure, doing everything needed to keep you safe and comfortable." • "I will give you medications during your procedure to keep you comfortable and to create good feelings in your stomach." • "You should wake up feeling comfortable and pleasantly hungry." • "It is time to take a nap. Pick out a wonderful dream and know that I will take excellent care of you while you are asleep." • "You may feel some warmth in your IV as this medicine goes in. That feeling will go away soon."

I remember after a personal surgery, the nurse came in and woke me up at 3:00AM to ask me what my pain scale was. If it happened to me, I know it has happened to others. Think of this. Our bodies heal during sleep and the hospital is the hardest place to get a comfortable night's sleep. It takes a minimum of six hours sleep for the body to properly rejuvenate itself. "What is your pain score 0-10." Does common sense not say that if you are sleeping your pain is being managed appropriately? So many times we bypass our common sense to do a procedure with no considerations of patient needs.

We forget about the affect of the environmental and background noises that affect patient outcomes, especially in critical care areas. We simply carry on our personal conversations, forgetting that the hospital is more than just a workplace and that patients easedrop on our conversations.

We as nurses can change and enhance patient outcomes simply by the language we use and the way we listen to our patients. Therefore, I recommend we listen without being judgmental, avoid unnecessary noise, keep areas quiet and professional, and use softer tones. Avoid jargon; keep it simple without "talking down" to patients or families.

We can also critique each other. We can think of more accurate, more precise ways of describing things. Nursing is the most trusted profession therefore patients listen to us like a dog listens to its master. Dave Berry described this when he wrote: "You can say any fool thing to a dog, and the dog will give you this look that says, `My God, you're RIGHT! I NEVER would've thought of that!" Patients take what nurses say literally, so beware of what is said.

About the Author: Michael R. "Ron" Eslinger, Captain, U.S. Navy, Retired is a Board Certified Hypnotherapist, Advanced Practice Nurse, Certified Master Hypnotherapy Instructor and Certified Registered Nurse Anesthetist. Fellow the National Council of Hypnotherapy (United Kingdom). He is the Past President, Virginia Association of Nurse Anesthetists and President Elect the Tennessee Nurses Association District 2. He is the Founder/Director of Healthy Visions Wellness Center in Oak Ridge, TN USA. For more information regarding hypnosis as an adjunct therapy, call 865-220-0777 or www.eslinger.net.

HI Ron, Many thanks for this thorough, insightful piece. In my work with those who care for others, I have long been aware of the degree to which what people are doing and what they are saying/who they are being while they're doing it, are far too often counterproductive. You have beautifully captured some of the more essential aspects that could facilitate an acceleration of healing in the patient and an acceleration of personal evolution in the caregiver/practitioner. I particularly loved the table with the specifics from which those who are unfamiliar with the extent of alternatives can easily select a more life-enhancing exchange. Bravo!